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Updated: Aug 17, 2026
Neuronavigation and Laparoscopy Guided Ventriculoperitoneal Shunt Insertion for the Treatment of Hydrocephalus
Published on: October 14, 2022
Unusual findings during abdominal placement of a ventriculoperitoneal shunt: report of three cases
R Shane Tubbs1, Elizabeth C Tyler-Kabara, John C Wellons
1Department of Cell Biology and Section of Pediatric Neurosurgery, University of Alabama at Birmingham, USA. rstubbs@uab.edu
Insights
Infants undergoing myelomeningocele repair and VP shunt placement may experience unusual abdominal fluid, potentially blood-tinged chyle. This transient complication did not impact long-term outcomes.
Area of Science:
- Pediatric Surgery
- Neonatal Care
- Neurosurgery
Background:
- Myelomeningocele repair and ventriculoperitoneal (VP) shunt placement are standard procedures for infants with myelodysplasia.
- Abdominal complications following these procedures are rare but require careful consideration.
Observation:
- Three infants undergoing myelomeningocele closure and VP shunt placement presented with unexpected dark or creamy fluid in the peritoneal cavity.
- Fluid samples were analyzed and found to be consistent with blood-tinged chyle.
- No history of abdominal birth trauma was noted in these cases.
Findings:
- The presence of chyle is hypothesized to result from mechanical stress during myelomeningocele repair, potentially rupturing lymphatic and blood vessels.
- An alternative theory suggests hepatic compression during closure may elevate intraportal pressure, causing chyle to weep from the gastrointestinal tract.
- Cultures of the fluid were nondiagnostic.
Implications:
- This transient fluid accumulation did not lead to chronic ascites, VP shunt infection, or dysfunction.
- Long-term follow-up indicated no issues with abdominal visceral function.
- Understanding this rare complication can aid in surgical planning and patient monitoring.
Abstract:
The authors present three cases of infants born with myelodysplasia. Each infant underwent closure of a myelomeningocele and within 2 to 4 days placement of a ventriculoperitoneal (VP) shunt. In each case, on opening the peritoneal cavity, the authors observed egress of a dark or creamy dark fluid. None of the patients had a history of abdominal birth trauma. The decision was made to continue the procedures and send samples of the unusual fluids to the laboratory for culture and analysis. The cultures proved to be nondiagnostic and the characteristics of the fluid samples were most consistent with those of blood-tinged chyle. The authors hypothesize that, occasionally, the mechanical tautness that is created with repair of myelomeningoceles is sufficient to rupture small lymphatic vessels and accompanying blood vessels of the abdomen. An alternative hypothesis is that abdominal compression due to closure of the myelomeningocele may temporarily compress the liver, leading to raised intraportal pressures and resulting in weeping of chyle from the gastrointestinal tract. This abnormal fluid accumulation did not lead to chronic ascites, VP shunt infection, or dysfunction at long-term follow-up examination and abdominal visceral function has not been an issue.